课件：泌尿系统感染.pptx

泌尿、男生殖系统感染 Urologic infection教学目的与要求1. 了解泌尿、男生殖系统感染的发病概况。2. 了解肾、前列腺和附睾感染的类型、症状、诊断与治疗原则。3. 熟悉膀胱炎（尤其是女性）反复发作或久治不愈的原因和对策。4. 熟悉慢性前列腺炎的诊断和综合治疗方法。5. 了解性传播性疾病。 定义 Definition病原微生物侵入泌尿、男生殖系统内繁殖而引起的炎症。通常称尿路感染，又分上尿路感染和下尿路感染。由于男性后尿道有射精管开口，故泌尿系与生殖系感染互相传播。The invasion of pathogenic bacteria or other organisms--any position of the urinary tract--Inflammation. Generally termed as the urinary tract Infection, which can be subdivided as infection of upper or lower urinary tract. With the ejaculatory duct orifice at the posterior urethra of male, the infection can disseminate between the urinary and the genital tract.pathogens病原微生物G-杆菌，60%~80%大肠埃希菌，其它副大肠埃希菌、变形、绿脓杆菌等。G＋菌，约20％。 金黄色葡萄球菌常见及链球菌等。其他：TB 、衣原体、支原体、淋病奈瑟菌、真菌、原虫、病毒等。G-rods, 60%~80% Bacterium coli, Bacterium aeruginosum, Proteus sp etc.G+cocci:20％ Staphylococcusaureus, Streptococcus etc.Others: TB、Chlamydiae, mycoplasma，gonococci ，mycoplasmas, protozoon，Virus.发病机制： 1、正常菌群（乳酸杆菌、链球菌）对致病菌起抑制平衡作用。尿液酸碱度、渗透压、尿素、有机酸不利细菌繁殖。 2、细菌毒力强。表达K抗原的大肠杆菌毒力强易致感染。 3、 致病菌菌毛产生粘附素与尿路上皮细胞受体结合致感染。 4、尿路细胞分泌黏液含粘蛋白、氨基葡萄糖聚糖、粘多糖等起保护作用。致病菌与黏液结合损害保护层致感染。诱 因Host susceptibility factors 仅有致病菌不一定感染，诱因作用重要。1、抵抗力减弱：慢性消耗性疾病，免疫力 减低，糖尿病等。Merely pathogens do not necessarily leads to infection. Susceptibility factors are important.1. Lowed resistance: chronic consuming disease, declined immunity, diabetes etc.2、梗阻： 结石、肿瘤、狭窄、畸形等，致尿液滞留、冲洗作用减弱。2 .Obstruction: stone, tumor, stenosis, malformation,etc. leading to urine stasis and weaken the flush effect of the urine.诱因 Host susceptibility factors3、医源性：器械检查、治疗、如导管、内窥镜操作；擦伤粘膜，引入致病菌；糖皮质激素作用，放射治疗。 3 .Iatrogenic factors：Instrumental exam, therapy, such as manipulation with catheter and endoscope. Injure the mucosa and bring bacteria; the complication of glucocorticosteroid, radiation therapy.4、解剖因素： 先天性输尿管回流，妇女尿道短、尿道口异常、小儿包茎等。4. anatomic factors: congenital vesicoureteral reflux, abnormal orifice of the female uretera, redundant prepuce, etc.感染途径Route of infection四种,最常见为上行及血行。上行感染:G－杆菌常见。血行感染:金葡菌常见。淋巴感染:淋巴管似一座 “桥梁”。直接感